Pancreas divisum and "santorinicele": Diagnosis with dynamic MR cholangiopancreatography with secretin stimulation

PURPOSE: To evaluate the usefulness of magnetic resonance(MR) cholangiopanc reatography (MRCP) before and after secretin administration in diagnosing s antorinicele in patients with pancreas divisum. MATERIALS AND METHODS: One hundred seven patients suspected of having pancr eatic disease underwent MRCP before and after secretin administration (S-MR CP). S-MRCP images were evaluated for pancreas divisum and santorinicele an d for size of the main pancreatic duct and santorinicele. The onset of duod enal filling was calculated on dynamic S-MRCP images. RESULTS: Pancreas divisum was detected in five (5%)of 107 patients at MRCP and in 10 (9%) of 107 patients at S-MRCP. Santorinicele was detected in thr ee (21%) of 14 patients at MRCP and in an additional four (seven [50%] of 1 4) patients at S-MRCP in patients with pancreas divisum. Santorinicele was confirmed in six of seven patients at endoscopic retrograde cholangiopancre atography (ERCP); in one of seven patients, ERCP was unsuccessful. The duct of Santorini was significantly (P < .05) larger in the pancreatic head in patients with pancreas divisum and santorinicele (3.6 mm) compared with tho se with only pancreas divisum (2.2 mm). A noteworthy reduction in size of t he pancreatic duct (26%) and of the santorinicele (63%) was observed after sphincterotomy. The onset of duodenal filling was delayed significantly in patients with santorinicele (2.1 vs 1.3 minutes; P < .05). CONCLUSION: S-MRCP helps in identifying pancreas divisum and santorinicele, which may be the cause of impeded pancreatic outflow.